This article is more than 5 years old. Information may no longer be current.
Short sleeves reduce risk for pathogen transmission
Click Here to Manage Email Alerts
SAN DIEGO — Simulated patient care interactions showed that the cuffs of physicians’ long-sleeved white coats could contribute to the transmission of pathogens, leading researchers to recommend short sleeves.
Prior research has shown that physicians’ white coats are rarely cleaned and often contaminated. These findings have prompted a “bare below the elbows” dress code policy in the U.K. However, whether short sleeves decrease the probability of pathogen transmission remains unknown, according to Amrita John, MD, from the division of infectious diseases and HIV medicine at Case Western Reserve University.
John and colleagues randomly assigned 34 health care professionals to wear either long- or short-sleeved coats in a randomized cross-over trial to examine pathogen transmission. They created simulated patient care interactions, asking personnel to examine a mannequin contaminated with cauliflower mosaic virus DNA and then examine an uncontaminated mannequin. The investigators compared the frequency of transferred DNA to the sleeves and/or wrists and to the uncontaminated mannequin. They observed how frequently the sleeves of white coats came in contact with patients or the environment both during these simulated patient care interactions and during work rounds.
The results showed that no transmission occurred when short-sleeved coats were worn during simulations of patient care. The sleeve cuff of long-sleeved coats often contacted the patient/mannequin or the environment during both work rounds and simulated examinations, and sleeve cuffs of the long-sleeved coats had frequent contamination with the DNA marker.
“In 26.47% of interactions when long-sleeved coats were worn, it was noted that the sleeve cuffs and wrists were found to be contaminated with the DNA marker. After examining the first mannequin, no such contamination was noted with short-sleeved coats,” John said during her presentation. “It was then noted that in 14.7% of interactions when long-sleeved coats were worn, the environment of the second mannequin was contaminated with the DNA marker — and again, no contamination with short sleeves.”
Out of 34 simulations when personnel who wore long-sleeved coats, five coat cuffs showed signs of contamination, whereas none of the personnel in short-sleeved coats showed any contamination. In around 5% of simulations, the second mannequin showed evidence of the DNA marker. Researchers also observed that health care personnel who wore long-sleeved coats were less likely to include their wrists when washing their hands between simulations.
“My take-home message would be that we already have guidance both from the U.K. and from the Society for Healthcare Epidemiology of America indicating that short-sleeved clothing would be beneficial in preventing pathogen transmission in health care settings,” John told Infectious Disease News in an interview. “I believe this study provides more evidence to that statement.” – by Savannah Demko
Reference:
John A, et al. Abstract 996. Presented at: IDWeek 2017; Oct. 4-8, 2017; San Diego.
Disclosures: The authors report no relevant financial disclosures.
Perspective
Back to Top
Keith S. Kaye, MD, MPH
This interesting study raises additional questions regarding the risks of pathogen transmission associated with wearing a long-sleeved white coat in the hospital. Although the study demonstrated that white coats were associated with a higher risk of contamination of wrists/sleeves and transfer of DNA marker to a mannequin, it remains unclear what sort of absolute risk long-sleeved white coats pose in the clinical setting with actual patients, particularly in relation to hand hygiene and environmental contamination.
Perspective
Back to Top
Michael Angarone, DO
This is an interesting look at how the clothing we wear may result in the transmission of pathogens. The idea behind the use of personal protective gloves and gowns is to reduce the likelihood of acquisition and then transmission of pathogens from a contaminated patient to a noncontaminated patient. Many have wondered about standard clothing that we all wear on a daily basis, namely long-sleeved white coats and long neck ties. Neck ties have been linked to the transmission of pathogens in experimental models. Like the neck tie study, this study identifies the transmission of a cauliflower mosaic virus. The virus contaminated those that wore long sleeve jackets more commonly than those with short sleeves. However, there was only one transmission to an uninfected “patient.” This study informs us that there may be a risk when wearing long sleeves, but it does not prove that long sleeves are transmitting pathogens to uninfected persons. The best practice remains regular and consistent use of hand hygiene practices.
References:
McGovern B, et al. J Hosp Infect. 2010;doi:10.1016/j.jhin.2009.12.008.
Weber RL, et al. J Hosp Infect. 2012;doi:10.1016/j.jhin.2011.12.012.
Click Here to Manage Email Alerts